Angioplasty, No Free Pass

Using a balloon to open clogged arteries reduces angina, but not the threat of a heart attack.

A recent study shows that many patients do not understand the purpose of undergoing an angioplasty. Doctors aren't immune from this confusion either.

Angioplasty is a procedure where clogged arteries are widened, improving blood flow. An inflatable balloon is inserted into an artery and once inside, is inflated. This crushes the fatty deposits that are clogging the artery, leaving more room for blood to flow through and improving blood flow.

Patients whose arteries are clogged but who are in no immediate danger of heart attack sometimes undergo angioplasty...In these patients, angioplasty does not reduce the chance of a future heart attack or death. But most patients think that it does.

An angioplasty is often performed after a heart attack or on a patient in immediate danger of having one.

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Other patients whose arteries are clogged but who are in no immediate danger of heart attack sometimes undergo angioplasty. In these patients, the only known benefit of the operation is to reduce the symptoms of angina attacks (temporary shortness of breath and chest pain). Aside from providing relief, this may also allow a patient to lead a more active lifestyle.

In these patients, angioplasty does not reduce the chance of a future heart attack or death. But most patients think that it does.

It seems reasonable that improved blood flow would lead to a host of benefits. And maybe it does. But right now, the only known benefits of elective angioplasty occur in patients who suffer from angina.

The study was of 153 patients with stable heart disease and varying symptoms. All were possible candidates for angioplasty. Fully 88% thought that an angioplasty would reduce their risk of heart attack. And almost 75% believed that if they did not undergo angioplasty, they would suffer a heart attack within the next five years. But 63% of their cardiologists understood that angioplasty would not reduce the patients' risk of heart attack; it would only reduce angina symptoms.

This isn't all that surprising. After all, the cardiologists went to medical school. Most of the patients did not. It does point out the large disconnect between what doctors know about angioplasty and what patients think about it. It also seems to be saying that over one-third of cardiologists are confused about angioplasties, too.

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Ultimately, 53 of these patients underwent angioplasty. The incidence of angina in these 53 patients was about the same as in the 100 patients who did not undergo angioplasty.

Why do patients without angina symptoms undergo an angioplasty? Are these patients demanding them? Are they receiving the impression from their doctor that these operations are necessary or desirable? Is there a belief among doctors that even though there's only evidence of benefit in patients with angina symptoms, the operation may confer benefits that have not yet been proven?

Whatever the answers might be, there is clearly a lot of confusion about angioplasties.

An article detailing the study was published in the September 7, 2010 issue of Annals of Internal Medicine.